Site is not allowed to send claims to the specified payer

Rejection Message

Site is not allowed to send claims to the specified payer.

Rejection Details

This rejection has three possible causes:

1. The practice is not credentialed or enrolled with this payer.
2. Claims are being sent out with the incorrect billing information.
3. Claims are being submitted to the wrong payer ID.

Resolution

Resolution steps will vary depending on the cause:

1. If the practice is not credentialed or enrolled with the payer, please contact the payer for further assistance.
   1. Verify what Provider IDs the payer has on file to determine what information the claimed should be billed under.
      1. Is the Provider enrolled with their Group NPI or Individual NPI?
      2. Is the Provider enrolled with their Tax ID or SSN?
   2. Verify if there are any additional payer-assigned Provider IDs that also need to be submitted on the claims. If so, what loop and segment should the information be populated in?
   3. Verify the Payer ID used is correct/valid for the policy information submitted.
2. If the claim was sent with different billing information than what is on file with the payer, verify and edit the billing information.
3. If the claim is submitted to the wrong payer ID, verify and edit the payer ID.

When all corrective actions are completed, verify enrollment is completed (or not needed) before submitting e-claims. Then, rebill and resubmit all affected claims.